The Terrace Like Cranial Extension of the Temporal Prehairline Incision

If there is a bunching up of skin in the temporal area, the prehairline technique can be extended cranially by a stepwise superposition of fusiform skin excisions in the temporal zone and the lateral forehead [13, 17].

These complementary incisions are done without any skin undermining just to flatten down the skin cranial to the point where the prehairline sideburn incision ends, to redrape bunching-up skin higher up.

To strictly avoid visible scars, it is of special importance that these additional skin excisions are placed horizontally or slightly curved, never vertically (Figs. 44.17, 44.18), so that they are covered by the overlaying hair.

Fig. 44.17. The stepwise terrace-like cranial extension of pre-hairline incisions

A combination of cervicofacial rhytidectomy with a browlift is the most complete facial rejuvenation!

In a high forehead, it is advisable to perform this as endoscopically controlled prehairline biplanar forehead advancement [14]. The incision lines are not coherent, but the sideburn prehairline incision at the level of the upper pole of the helix and the forehead incision are performed as separate incisions horizontally. The prehairline incision at the frontal hairline "feathers" into the lateral hair-bearing zone on each side.

Fig. 44.18. Patient of 49 years of age, a before, b 1 week after and c 3 months after SACS rhytidectomy and terrace lifting. Note the inconspicuous scars positioned in the same "geometry" as the overlaying hair is directed
Fig. 44.19. a Preopertive and b postoperative pictures: prehairline cervico-facial rythidectomy combined with endoscopically controlled biplanar prehairline forehead advancement and a perioral and lip microfatgrafting [4] for complete facial rejuvenation
Hairline Incision

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